Objective:To summarize the experience of surgical methods without repairing the fistula for 92 cases with gastrointestinal intrathoracic fistula.Methods:The surgical methods without repairing the fistula were performed through VATS, small incision assisted with VATS or thoracotomy. The focus of the surgery was to promote lung expansion, eliminate the residual cavity of chest cavity and keep effective drainage. After entering the chest cavity from the affected side, wash chest cavity with a large amount of warm normal saline and sterilize intermittently with iodophor to ensure the sterile environment in the pus cavity. Then completely remove the pleural cellulose or fiberboard on visceral pleura to promote lung expansion, eliminate the residual cavity of the chest cavity. The fistula was covered tightly and supported firmly by the visceral pleura on the lung. Multiple T-tubes were placed in thoracic cavity and fistula to keep effective postoperative drainage.Results:Among 92 cases, 85 cases were cured and the cure rate was 92.4% (85/92).7 cases died and the mortality rate was 7.61% (7/92). The 7 dead cases include 5 cases with esophagogastric anastomotic fistula (the death of 3 cases was cause by aortic esophagogastric fistula, the death of 1 case was cause by thoracic gastric tracheal fistula and 1 case was dead because of pulmonary infection and respiratory failure), 1 case with esophageal rupture (the cause of death was septic shock ), and 1 case with esophageal perforation(the cause of death was pulmonary infection and respiratory failure).Conclusion:Most of the surgeries without repairing gastrointestinal intrathoracic fistula are conducted simply through VATS or small incision assisted with VATS., which is safe and effective.

Objective:To screen, obtain domestic and foreign evidence on the prevention and treatment of nausea and vomiting during pregnancy, and evaluate and summarize the quality of the evidence.Methods:We searched the Joanna Briggs Institute (JBI) , UpToDate, the Cochrane Library, PubMed, British Medical Journal (BMJ) , Chinese Biomedical Literature Database, China National Knowledge Infrastructure (CNKI) , WanFang Data, Yimaitong, VIP by computer. The search time limit was from January 1, 2011 to January 1, 2021. Four researchers independently screened the articles, and extracted and summarized the evidence that met the quality standards.Results:A total of 16 articles were included, including 4 guidelines, 1 evidence summary, 8 systematic reviews, 2 Meta-analysis and 1 expert consensus. Through the screening and acquisition of evidence for the prevention and treatment of nausea and vomiting during pregnancy, the 32 best evidences were finally summarized from 7 aspects including assessment and diagnosis, classification and grading, risk factors, basic management principles, prevention, non-drug treatment, and drug treatment.Conclusions:The prevention and treatment of nausea and vomiting during pregnancy should first evaluate the patient, determine the patient's symptoms and severity, analyze the risk factors, and conduct cognitive, psychological, and behavioral interventions for the patient, as well as non-pharmacological or drug treatment.

Objective:To analyze the malignant probability of thyroid nodules with the diagnosis of atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) determined by fine-needle aspiration (FNA) and to explore the value of the combined application of BRAFV600E gene detection for the diagnosis of benign and malignant thyroid nodules. Methods:A total of 114 patients including 20 males and 94 females, aged 16-76 years old with thyroid nodules underwent FNA examination and surgical treatment in the Affiliated Cancer Hospital of Zhengzhou University from October 2018 to November 2019 were retrospectively analyzed. Postoperative histopathological results were used as the gold standard for the diagnosis of malignant thyroid nodules. The malignant rate of thyroid nodules with the diagnosis of AUS/FLUS was evaluated. Differential diagnostic efficacy of preoperative FNA combined with BRAFV600E gene detection for papillary thyroid carcinoma (PTC) was analyzed by McNemer test and diagnostic test evaluation method. Results:The mutation rate of BRAFV600E gene was 84.76% (89/105) in PTC. PTC accounted for 57.14% (12/21) of the patients with the diagnoses of AUS/FLUS determined by FNA. The specificity, sensitivity, positive predictive value and negative predictive value of BRAFV600E mutation examination for the diagnosis of malignant thyroid nodules determined preoperatively as AUS/FLUS were 9/9, 5/12, 5/5 and 9/16, respectively. BRAFV600E mutation examination could improve the detection rate of PTC in patients with AUS/FLUS ( OR=0.438, 95% CI=0.251-0.763, P=0.016). Conclusion:FNA combined with BRAFV600E mutation examination can significantly improve the detection rate of malignant thyroid nodules diagnosed preoperatively as AUS/FLUS.

Objective:To study the clinical pathological features of patients with relapsed diffuse large B-celllymphoma (DLBCL) and to provide evidence for early clinical screening of recurrent cases.Methods:The clinical and pathological data of the 20 patients, who had relapsed DLBCL (relapsed group) and were admitted to the First Affiliated Hospital of Nanjing Medical University from January 2015 to December 2019, were included. Meanwhile, other 34 patients with DLBCL who had achieved complete response (CR) for 36 months or more (CR group) were used as controls.Statistical methods were used to retrospectively analyze the differences in general conditions, clinical characteristics, lab resultsand pathological features between the two groups.Results:Clinically, there were 6 males and 14 females with a median age of 55.5 (33-85) years in the relapsed group and 14 males and 20 females with a median age of 53 (15-89) years in the CR group. The relapsed and CR groups had significant difference in Ann Arbor stage ( P=0.001), International Prognostic Index score ( P=0.006), primary lesions ( P=0.003), extranodal involvement ( P=0.002), and hepatitis B viral infection ( P=0.046), β2-MG level ( P=0.029), LDH level ( P=0.005) and CRP level ( P=0.006), while the age ( P=0.732), gender ( P=0.416), ECOG score ( P=0.248), B symptoms ( P=0.511), the presence of hypoalbuminemia ( P=0.279), anemia ( P=0.983) and A/G( P=0.416) showed no statistical difference.Pathologically, compared with the CR group, the relapsed group was mostly non-GCB type (85% vs. 59%, P=0.048), with a higher CD5 positive rate (25% vs.3%, P=0.014) and a lower bcl-6　positive rate (60% vs. 88%, P=0.017), while the expression of Ki-67, CD10, bcl-2, MUM1, CD20 and PAX5 was not different between the two groups. Conclusion:Most of the patients with relapsed DLBCL are non-GCB type. The patients with CD5 positivity, stage III-IV, International Prognostic Index score 3-5, nodal origin, often involving>1 extranodal organ, abnormally elevated LDH, CRP and β2-MG level, and HBV infection are more likely to relapse.

Objective To compare the effects of propofol-and sevoflurane-based anesthesia on postoperative cognitive dysfunction in elderly patients undergoing cardiac valve operation under cardiopulmonary bypass (CPB).Methods Eighty patients of both sexes,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,aged 65-72 yr,weighing 60-80 kg,scheduled for elective cardiac valve operation under CPB,were randomly divided into 2 groups (n =40 each) using a random number table:propofol-based anesthesia group (group P) and sevoflurane-based anesthesia group (group S).In group P,propofo] was given by target-controlled infusion with the target plasma concentration of 0.5-2.0 μg/ml to maintain anesthesia.In group S,0.5％-2.5％ sevoflurane was inhaled for maintenance of anesthesia.Immediately after induction of anesthesia,at the end of operation,and at 6,12 and 24 h after operation,blood samples were taken from the superior vena cava for determination of plasma matrix metalloproteinase-9,S100β protein and neuron-specific enolase concentrations.Cognitive function was assessed at 1 day before operation,and at 3,7 and 30 days after operation.Results Compared with group P,the plasma matrix metalloproteinase-9,S100β protein and neuron-specific enolase concentrations at the end of operation and at 6 h after operation and incidence of postoperative cognitive dysfunction were significantly increased in group S (P ＜ 0.05).Conclusion Propofol-based anesthesia provides better cerebral protection than sevoflurane-based anesthesia,and the development of postoperative cognitive dysfunction is decreased in elderly patients undergoing cardiac valve operation under CPB.

Objective To compare the cerebral protective effect of propofol and sevoflurane combined with sufentanil anesthesia in the patients undergoing valvular surgery under cardiopulmonary bypass (CPB).Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 60-70 yr, scheduled for elective valvular surgery under CPB, were randomly divided into either propofol-based anesthesia group (group PA) or sevoflurane-based anesthesia group (group SA) , with 30 patients in each group.From induction of anesthesia to the end of surgery, group P received targetcontrolled infusion of propofol 0.5-2.0 μg/ml, and group S continuously inhaled 0.5％-2.5％ sevoflurane.Bispectral index value was maintained at 45-55.Immediately after induction (T0), at the end of surgery (T1) , and at 6, 12 and 24 h after surgery (T2-4) , the superior vena cava was retrogradely cannulated for blood sampling, and the concentrations of plasma S-100β protein and neuron-specific enzyme were determined using enzyme-linked immunosorbent assay.Results Compared with group SA, the plasma S-100β concentrations at T1,2 and neuron-specific enzyme concentrations at T1-3 were significantly decreased in group PA.Conclusion The cerebral protective effect of propofol combined with sufentanil anesthesia is superior to that of sevoflurane combined with sufentanil anesthesia in the patients undergoing valvular surgery under CPB.

Objective To study the rule of lymph node metastasis rate in cN 0 papillary thyroid microcar-cinoma( cN0-PTMC) and to evaluate an appropriate region of neck dissection .Methods Data of 233 cases of cN0-PTMC were retrospectively analyzed .Univariate analysis with chi-square test was used to analyze the statisti-cal correlation between gender , age, tumor diameter and lymph node metastasis respectively .Results 81 out of 233 patients(34.8%)had cervical lymph node metastasis (30.0%in central region and 9.9%in lateral region). For patients with tumor diameter ( D)≤5 mm and D>5 mm, lymph node metastasis rate in central region was 21.6%and 36.6%(χ2 =6.199,P<0.05) and it was 4.9% and 13.7% respectively in lateral region (χ2 =5.035,P<0.05).For male and female patients, lymph node metastasis rate in central region was 42.1% and 26.1%respectively(χ2 =5.224,P<0.05), and it was 21.1% and 6.3% respectively in lateral region (χ2 =10.604,P<0.01).Lymph node metastasis rate in patients≤45 years old and >45 years old was 37.9% and 21.1% respectively (χ2 =7.792, P <0.01 ) .The lateral region lymph node metastasis rate was 17.1% and 6.7%when the central region lymph node was infringed or not (χ2 =5.947, P<0.05).Conclusions All cN0-PTMC patients should have a normative central neck dissection .Male patients with PTMC and tumor diameter >5 mm should receive the lateral neck lymphoid tissue exploration during surgery in order to find subclinical metas -tasis.

OBJECTIVE: Through preoperative temporary balloon occlusion of internal carotid artery and monitoring of carotid artery stump pressure variation, in order to further predict the risk of carotid artery ligation and resection, evaluation operative risk and provides the reference for the choice of surgical approach. METHOD: Continuous monitoring and recording the carotid artery stump return pressure,before clamping and in the process of blocking, close observation the patients mental state and the nervous systemof all kinds of signs, in the process of blocking, to understand the dynamic change of stump artery pressure return in patients and whether can the smooth passage of carotid artery balloon occlusion test. RESULT: Of the 19 patients, 4 cases were positive, 15 negative cases, Blocking immediate the positive patients and negative patients with stump pressure drop was (57. 35 ± 1. 89) % and (38. 99 ± 12. 23) %, with statistical significance between the two, in the process of blocking, the mean stump pressure of the positive patients and the negative patients was (37. 29 ± 3. 15) mmHg and (61. 36 ± 14. 69) mmHg, with statistical significance between the two. CONCLUSION Approximately 21. 05% of patients can not tolerate carotid artery balloon occlusion test, theory for carotid artery reconstruction operation. After blocking the stump pressure is less than 40. 44 mmHg, the theory for reconstruction of the internal carotid artery operation. Blocking instant artery stump pressure dropped more than 55. 46%, in theory the need for internal carotid artery reconstruction.
Balloon Occlusion ; Blood Pressure ; Carotid Artery, Internal ; surgery ; Feasibility Studies ; Humans ; Ligation ; Preoperative Care ; Risk Assessment ; Vascular Surgical Procedures

ObjectiveTo compare the sensitivity and specificity of a new index of insulin resistance (IR) derived from plasma triglyceride and glucose with homeostasis model assessment for insulin resistance index ( HOMA-IR) and insulin sensitivity index from frequent sampling intravenous glucose tolerance test (FSIGT-ISI).Methods A total of 1024 subjects (240 normal control,335 with obesity,312 impaired glucose regulation,and 137 type 2 diabetes mellitus) were included in the present study.Standard oral glucose tolerance test,insulin release test,lipid profiles,and other biochemical markers were measured. Among them 540 subjects were selected to undertake FSIGT.TyG index is derived from plasma triglyceride and fasting glucose.TyG2 index is derived from plasma triglyceride and postprandial 2 plasma glucose.ResultsPearson correlation coefficient between TyG and HOMA-IR or FSIGT-ISI was 0.427 ( P＜0.01 ) and -0.100 ( P=0.024 ),respectively,and that between TyG2 and HOMA-IR or FSIGT-ISI was 0.455 ( P＜0.01 ) and - 0.162 ( P＜0.01 ),respectively.The sensitivity and specificity of TyG index for diagnosis of IR was 68.5％ and 63.5％ compared with HOMA-IR,and 68.5％ and49.5％ compared with FSIGT-ISI.For TyG2 index,the slightly higher sensitivity ( 81.7％ with HOMA-IR,75.7％ with FSIGT-ISI),but lower specificity (51.5％ with HOMA-IR,48.2％ with FSIGT-ISI) were found.ConclusionsBothTyGandTyG2 indices could be used as a surrogate for assessing IR in Chinese subjects.However,considering its moderately high sensitivity but low specificity,these two indices are limited in the use of large-scale epidemiological screening.

Objective To compare the efficacy of patient-controlled intravenous analgesia (PCIA),patient-controlled paravertebral block (PCPB) and patient-controlled epidural analgesia (PCEA) in patients after lobectomy performed via video-assisted thoracoscope (VAT).Methods Forty-eight ASA Ⅰ or Ⅱ patients,aged 50-64 yr,with a body mass index of 20-25 kg/m2,undergoing elective lobectomy via VAT,were randomly divided into 3 groups ( n =16 each):PCIA group,PCPB group and PCEA group.PCIA solution contained sufentanil 2 μg/kg in 100 ml of normal saline,The PCA pump was set up with a 2 ml bolus dose,a 15 min lockout interval and background infusion at a rate of 2 ml/h.PCPB solution contained 0.75％ ropivacaine 60 ml in 250 ml of normal saline and the pump was set up with a 5 ml bolus dose,a 15 min lockout interval and background infusion at a rate of 5 ml/h.The PCEA solution contained 0.75％ ropivacaine 50 ml and sufentanil 1 μg/kg in 250 ml of normal saline.The PCEA pump was set up to deliver a 5 ml bolus dose with a 15-min lockout interval and background infusion at 5 ml/h.VAS score was maintained ≤3.Peripberal venous blood samples were obtained before operation ( baseline),and at 24 and 48 h after operation for determination of the plasma cortisol concentration.The side effects were recorded.Results The plasma cortisol concentration and incidence of Somnolence were significantly lower in groups PCPB and PCEA than in group PCIA ( P ＜ 0.05 ).The plasma cortisol concentration was significantly lower in group PCEA than in group PCPB ( P ＜ 0.05).Compared with the baseline value,the plasma cortisol concentrstion was significantly higher after operation in groups PCIA and PCPB ( P ＜ 0.05),while no significant change was found in group PCEA ( P ＞ 0.05).Conclusion Compared with PCIA,PCEA can inhibit the stress response,while PCPB can reduce the stress response with good safety in patients after lobectomy performed via VAT if they can provide the equivalent postoperative analgesia.